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Alternative plan offered to expansion of Medicaid in NH

By GARRY RAYNOState House Bureau

CONCORD — The State of New Hampshire would be able to provide low-income uninsured adults with the health care they need for $46 million a year without the constraints of the Medicaid program, a commission studying Medicaid expansion was told Tuesday.

Avik Roy, a senior fellow at the Manhatten Institute for Policy Research, said the plan would provide private catastrophic health coverage with a network of primary care physicians to provide health insurance for the 22,300 people who would qualify for expanded Medicaid coverage under the Affordable Care act.

But opponents said the proposal would require those between 100 and 138 percent of the federal poverty level to spend up to 40 percent of their income before basic coverage would begin and would shred the safety net for the state's poorest citizens. Under federal poverty guidelines, a family of four making $23,550 would be at 100 percent.

The rough outline of a plan was developed by Roy with suggestions from several Republicans including Sen. Nancy Stiles, R-Hampton, who is a member of the Commission to Study Expansion of Medicaid Eligibility.

"This will give them access to health care," Roy told the committee, "not access to a card that (claims) to do that."

Others called the plan ill-conceived and would have the state refuse several billion dollars in federal funds.

"Based on the information presented today by Mr. Roy", said Deb Fournier, policy analyst for the New Hampshire Fiscal Policy Institute, "it appears his plan would cost state more money, cover far fewer people and force them to pay a lot more out-of-pocket cost."

According to state health care officials, expanding Medicaid eligibility to 138 percent of the federal poverty level or about $15,000 for an individual, would add about 49,000 people to the state-federal health insurance program. The state's health care providers would receive about $2.4 billion over the next seven years and the state would have to spend about $18 million during that period.

Roy said if the state requires adults who earn between 100 and 138 percent of the poverty level to buy insurance on the health insurance exchange, the state would not only have to pay for the private insurance but also provide additional services equivalent to Medicaid's.

But if the state refuses to expand Medicaid, it could provide care to the 22,300 uninsured through a primary care physicians' network paying participating physicians $100 a month per patient.

A work requirement much like the Temporary Assistance for Families program would reduce the number of people on the plan by half, he said. Recipients would also have to pay 10 percent co-pays but they would have subsidized Health Savings Accounts.

The plan drew the interest of newly elected Senate President Chuck Morse, R-Salem, who called the plan a real opportunity for a New Hampshire specific solution.

"Republican senators share the goal of reducing the number of uninsured in New Hampshire and improving health outcomes," Morse said in a statement. "I believe the proposal developed by Sen. Stiles and outlined today by Dr. Roy offers an intriguing concept for how we can do so through the private insurance marketplace. It deserves significant further study — particularly related to the availability of federal waivers and cost-sharing subsidies for program enrollees — as an alternative to simply expanding the Medicaid program under the one-size fits all dictates of the federal government.

Democrats were quick to pan the plan, calling it reckless and irresponsible.

"In their radical right-wing crusade against everything Obamacare, New Hampshire Republicans have thrown commonsense to the wind in favor of their extremist Tea Party ideology," said state Democratic Party Communications Director Harrell Kirstein. "This scheme is surpassed in its fiscal irresponsibility only by its callous disregard for thousands of New Hampshire residents without health insurance.

He said the plan would cost the state $2.5 billion in federal funding and force struggling working people to pay $6,000 or $12,000 for a family out of their pocket before they would be covered for basic health services.

Commission member Rep. Neal Kurk, R-Weare, asked Roy if the state's best option is to expand Medicaid while the federal government pays 100 percent of the cost for the first three years and then institute a plan like Roy proposed.

Roy cautioned about expanding Medicaid, saying once those benefits are in place it would be difficult to end them. "There would be a lot of fiscal and political risks," he said.

Several members of the commission pushed Roy about his proposal, questioning how people would better served than if Medicaid were simply expanded.

Gov. Maggie Hassan and the Democratically-controlled House favor expanding eligibility, while the Republican-controlled Senate wants to take more time to study its effect on the state and its finances.

The commission meets again next Tuesday to begin developing its recommendations which are due Oct. 15.